上海地区重症手足口病住院患儿临床分析  

Clinical analysis of children with severe hand-foot-and-mouth disease in Shanghai

作　　者：严秀峰[1] 葛艳玲[1] 谢新宝[1] 沈军[1] 朱燕凤[1] 曾玫[1] 杨天娇[1] 王晓红[1] 俞蕙[1] 

机构地区：[1]复旦大学附属儿科医院感染传染科,上海201102

出　　处：《中华儿科杂志》2012年第4期271-275,共5页Chinese Journal of Pediatrics

摘　　要：目的分析2009至2010年我院传染科收治住院的重症手足口病患儿的临床及流行病学特点，寻找重症相关危险因素。方法收集2009年及2010年因手足口病住院，且临床分期2期及2期以上患儿的临床资料及相关实验室检查，共748例，进行回顾性分析。结果748例重症手足口病住院患儿中，2009年271例，危重症3期17例（6．3％）。2010年477例，3期7例（1．5％），3期危重病例比重较2009年降低（x2=12．836，P〈0．01）。临床表现2期患儿724例，3期危重症24例，其中7例死亡，3期患儿病死率与2期比较，差异有统计学意义（P〈0．01）。男470例（62．8％），女278例（37．2％），男女比为1．7：1。年龄3个月10d-12岁9个月，中位年龄25个月，以1～4岁为主，达577例（77．1％）。本组均有不同程度的发热，2期患儿热程（4．10±1．40）d，3期为（5．05±1．05）d，3期热程较2期长（t=3．173，P〈0．01）。四肢抖动（57．0％）及呕吐（62．3％）是重症患儿病程中最常见的伴随症状，肺水肿、肺出血是最严重的并发症。3期患儿血白细胞计数（14．8±6．25）×10^9／L，血糖（8．63±3．51）mmol／L，与2期患儿血白细胞计数（11．8±4．23）×10^9／L，血糖（5．51±2．14）mmo^L比较，差异有统计学意义（P〈0．01），而C反应蛋白及脑脊液白细胞计数2期和3期患儿差异无统计学意义。182例患儿行头颅MRI检查，表现异常者37例（20．3％），主要表现为脑干（11例）等部位的高信号，有1例3期重症死亡患儿表现为脑水肿。结论手足口病的流行有一定的区域性及季节性，与家庭经济、卫生条件和性别都有一定的关系。1～4岁儿童为手足口病高发年龄。高热持续不退，是重症危险因素。而外周血白细胞、血糖水平的升高，磁共振等影像学检查可作为实验室预警指标。Objective To retrospectively analyzed the clinical features and epidemiology of children with severe hand-foot-and-mouth disease during 2009 and 2010 in Shanghai to investigate some risk factors with fatal cases. Method All the clinical records and laboratory results of serious patients were collected. A retrospective study was performed. Result A total of 748 serious patients were enrolled into this study, and the ratio of male to female was about 1.7：1 ; 724 patients were categorized into stage 2 with 254 patients in 2009 and 470 in 2010; 24 patients were categorized into stage 3 with 17 in 2009 and 7 in 2010. The rate of severity in 2010（ 1.5% ） was lower than in 2009 （6. 3% ） （ X2 = 12. 836, P 〈 0. 01 ）. Seven patients of stage 3 died, with the fatality 29. 2%, which was higher than in stage 2 （ P 〈 0. 01 ）. The children aged between 3 months 10 days to 12 years 9 months with onset median age of 25 months. Among them, 77.1% patients aged between 1 and 4 years which also accounted for 79.2% of the fatal cases（19/24）. But there was no significant difference between the age and the severity（ X2 = 0. 804, P 〉 0. 05 ）. Fever（ 100% ）, vomiting（57.0% ） and myoclonus jerk（62. 3% ） were the most frequent symptoms occurred in those serious cases. The average period of fever in children of stage 2 and 3 was （4. 10 ± 1.40 ） d and （ 5.05 ±1.05 ） d, respectively, which indicated significant difference between the two groups （ t = 3. 173, P 〈 0. 05 ）. The average values of white-blood-cell counts and blood glucose in fatal patients were （ 14. 8 ± 6. 25 ） × 109/L and （8. 63 ±3.51 ）mmol/L. They were higher when compared to those in stage 2 with the white-blood-cell counts of （ 11.8 ± 4. 23 ） × 109/L and blood glucose of （5.51 ± 2. 14） mmol/L （ P 〈 0. 05 ）. But there was no significant difference in C-reactive protein or cerebrospinal fluid white-blood-cell counts; A total of 182 patients were enrolled for MRI study during the acute stage w

关 键 词：手足口病 肠道病毒71型 临床分析 

分 类 号：R725.1[医药卫生—儿科]